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Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis

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An Erratum to this article was published on 24 June 2015

Abstract

Purpose

To evaluate the impact of routine follow-up consultations versus standard of care for intensive care unit (ICU) survivors.

Methods

Systematic literature review from five databases (Cochrane CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL), reference lists, citation tracking, and ongoing/unpublished trials. Randomized controlled trials investigating post-ICU consultations in adults with outcomes such as quality of life (QOL), anxiety, depression, posttraumatic stress disorder (PTSD), physical ability, cognitive function, and return to work were included. Two reviewers extracted data and assessed quality independently. The mean differences, risk ratios, and 95 % confidence intervals were calculated depending on outcome measures.

Results

From 1544 citations, five trials were included (855 patients). The overall risk of bias was low in two trials, unclear in two trials, and high in one trial. The overall quality of evidence was low. The trials assessed follow-up interventions defined as consultations informing survivors about their ICU stay. One trial found no effect on QOL. Pooling data from two trials (n = 374) showed a protective effect on risk of new onset PTSD at 3–6 months after ICU (risk ratio 0.49, 95 % CI 0.26–0.95). There was no effect on other outcomes.

Conclusions

The evidence indicates that follow-up consultations might reduce symptoms of PTSD at 3–6 months after ICU discharge in ICU survivors, but without affecting QOL and other outcomes investigated. This review highlights that planning of future RCTs should aim to standardize interventions and outcome measures to allow for comparisons across studies.

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Acknowledgments

The study was supported by grants from the Danish Nursing Organization, The Novo Nordisk Foundation and Nordsjællands Hospital, University of Copenhagen, Denmark. None of these had any influence on the design or conduct of the study; data collection, data management, analysis, and interpretation of the data; or the preparation, or approval of the manuscript. They are not responsible for the content in this review. We wish to thank all the experts and main authors in this field for their collaboration and response, and librarians A. Larsen and J. Meelby for their assistance with the search strategy.

Conflicts of interest

No conflicts of interest have been declared by the authors.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Nordsjællands Hospital, University of Copenhagen, 3400, Hilleroed, Denmark

    J. F. Jensen

  2. Copenhagen University Hospital, Rigshospitalet, Abdominal Centre, Blegdamsvej 9, 2100, Copenhagen, Denmark

    T. Thomsen

  3. Research Unit, Department of Nursing, Nordsjællands Hospital, Metropolitan University College, 2200, Copenhagen, Denmark

    D. Overgaard

  4. Department of Anesthesia and Intensive Care, Nordsjællands Hospital, University of Copenhagen, 3400, Hilleroed, Denmark

    M. H. Bestle & D. Christensen

  5. University of Copenhagen, Rigshospitalet, Trauma Center, Blegdamsvej 9, 2100, Copenhagen, Denmark

    I. Egerod

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  1. J. F. Jensen
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  4. M. H. Bestle
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  6. I. Egerod
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Corresponding author

Correspondence to J. F. Jensen.

Additional information

Review registration: Protocol registered at Centre for Reviews and Dissemination, University of York, International prospective register of systematic reviews (PROSPERO), ID: CRD42013006644, available from http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42013006644.

Take-home message: Follow-up consultations for intensive care recovery have been provided as experimental initiatives rather than by theory-driven standardized approaches. Therefore we need to evaluate the current evidence to inform future interventions and strategies.

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Jensen, J.F., Thomsen, T., Overgaard, D. et al. Impact of follow-up consultations for ICU survivors on post-ICU syndrome: a systematic review and meta-analysis. Intensive Care Med 41, 763–775 (2015). https://doi.org/10.1007/s00134-015-3689-1

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